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Treatment of Ectopic pregnancy
Most ectopic pregnancies are chronic (and can be treated with planned but urgent surgery) rather than acute (requiring sudden emergency treatment).
Therefore the best treatment option for most ectopic pregnancies involves urgent planned surgery to remove the growing embryo. The embryo cannot be saved if it has begun to grow outside the womb. The operation is usually done by laparoscopic (keyhole) surgery involving a small incision (cut) in the abdomen. Keyhole surgery has fewer risks of surgical complications than open surgery, such as blood loss, but open surgery has slightly better results. Your doctor will discuss these options with you, deciding what is best based on your medical history.
Immediate emergency surgery is required if the fallopian tube has split and there is heavy bleeding.
A damaged fallopian tube will be repaired if possible. But if it is badly damaged, the tube will be removed to prevent further ectopic pregnancies from occurring at the same site. You still have a good chance of having future normal pregnancies if you only have one fallopian tube.
If an ectopic pregnancy is diagnosed early and there are few symptoms, it can sometimes be treated with a drug called methotrexate (unlicensed use) instead of surgery. This drug kills the cells of the growing embryo, but has side effects such as abdominal pain in many women. You will also need to be closely monitored with regular blood tests for the following few weeks. Traditionally methotrexate has been given by an injection into the muscles or directly into the fallopian tube, but recent evidence suggests that an oral tablet form (taken by mouth) may be more effective.
Sometimes a ‘wait and see’ approach is used, for ectopic pregnancies that are diagnosed early, or for pregnancies where it’s not been confirmed where the egg is (because it can’t be found on a transvaginal ultrasound). This can be an alternative to surgery because many ectopic pregnancies will miscarry naturally. However, this is not advised often, because there is still a risk that the fallopian tube will rupture and cause internal bleeding.
A new treatment that requires more testing is fimbrial expression, when the fertilised egg is ‘milked’ out of the end of the fallopian tube.
